By: DelCharco M.D. OB/GYN
Abnormal uterine bleeding is one of the most common reasons women seek gynecologic care. It encompasses a wide range of bleeding patterns that fall outside what is considered normal, including periods that are too heavy, too frequent, too long, or too unpredictable, as well as bleeding that occurs between periods, after intercourse, or after menopause. While abnormal uterine bleeding is rarely a gynecologic emergency, it is also never something to simply wait out. At DelCharco M.D. OB/GYN in Ocala, Florida, we evaluate and treat abnormal uterine bleeding every day, and we want every patient to understand what may be causing it and what can be done.
“I thought that Paula was thorough, I understood the results and agreed with her for a six month check up. We agreed on further treatment and I was very pleased.”
—DelCharco M.D. OB/GYN Patient Testimonial
What Counts as Abnormal
Normal menstrual bleeding occurs roughly every 21 to 35 days, lasts between two and seven days, and involves a predictable amount of blood loss. The following patterns fall outside this range and warrant evaluation:
Heavy menstrual bleeding (menorrhagia): Soaking through a pad or tampon every hour for several consecutive hours, passing clots larger than a quarter, or bleeding that disrupts daily activities. This is one of the most common presentations of abnormal uterine bleeding and has a wide range of potential causes.
Irregular bleeding: Periods that vary significantly in timing, cycles shorter than 21 days or longer than 35 days, or periods that are difficult to predict.
Intermenstrual bleeding: Bleeding or spotting between periods, including after intercourse. This is always worth reporting to a provider, as it can signal a range of conditions from benign polyps to cervical or endometrial abnormalities.
Prolonged bleeding: Periods lasting more than seven days.
Postmenopausal bleeding: Any vaginal bleeding after 12 consecutive months without a period. This category requires its own evaluation pathway and should never be attributed to other causes without assessment.
Common Causes
Abnormal uterine bleeding has many possible causes, which is why evaluation rather than assumption is essential. The most common include:
Uterine fibroids: Noncancerous growths of the uterine muscle wall are among the most common causes of heavy menstrual bleeding in women of reproductive age. They can range from microscopic to quite large and may cause pressure, bloating, and urinary symptoms in addition to heavy periods.
Endometrial polyps: Noncancerous growths in the uterine lining that can cause irregular or intermenstrual bleeding.
Hormonal imbalances: Conditions including PMOS (Polyendocrine Metabolic Ovarian Syndrome, formerly known as PCOS), thyroid dysfunction, and changes associated with perimenopause can all disrupt the hormonal signaling that governs the menstrual cycle, resulting in irregular or abnormal bleeding.
Adenomyosis: A condition in which endometrial tissue grows into the muscular wall of the uterus, causing heavy, painful periods and a boggy, enlarged uterus.
Endometrial hyperplasia: Overgrowth of the uterine lining, often associated with estrogen exposure without progesterone balance. A precancerous condition that requires prompt treatment.
Endometrial or cervical cancer: While malignancy is not the most common cause of abnormal uterine bleeding, it must be ruled out, particularly in older women, postmenopausal women, or those with relevant risk factors.
How Abnormal Uterine Bleeding Is Evaluated
Evaluation begins with a thorough medical history, including details about the bleeding pattern, associated symptoms, medications, and any relevant personal or family history. A pelvic exam is performed, followed typically by a pelvic ultrasound to assess the uterus, ovaries, and endometrial lining. Depending on findings, additional evaluation may include an endometrial biopsy, hysteroscopy, or lab work including a complete blood count to assess for anemia, thyroid function tests, and hormone levels.
The Hidden Consequence: Iron Deficiency Anemia
One of the most common and underrecognized consequences of chronic heavy menstrual bleeding is iron deficiency anemia. When a woman loses more blood than her body can adequately replace over repeated cycles, iron stores become depleted and red blood cell production falls. The result is fatigue, weakness, difficulty concentrating, and shortness of breath that many women attribute to busy schedules or poor sleep rather than to their periods.
Iron deficiency anemia from heavy periods is entirely treatable once the underlying cause of the bleeding is addressed. But because the symptoms develop gradually, many women do not connect how they feel to their menstrual bleeding, and they continue losing significant amounts of blood cycle after cycle without seeking care. If you have been experiencing persistent fatigue alongside heavy periods, asking your provider to check your blood count is a worthwhile step.
Hormonal therapy: Hormonal approaches including combined oral contraceptives, progestin-only options, or the hormonal IUD can regulate cycles and significantly reduce bleeding. For women approaching menopause whose bleeding is related to hormonal fluctuation, hormone replacement therapy may be part of the management strategy.
Procedural options: Endometrial ablation, available as an in-office procedure, destroys the uterine lining and substantially reduces or eliminates menstrual bleeding for many women. It is appropriate for women who do not wish to become pregnant. For women with fibroids or other structural causes of bleeding, surgical options range from minimally invasive fibroid removal to hysterectomy when other approaches have not been effective.
Treating underlying conditions: When abnormal bleeding is driven by thyroid dysfunction, PMOS, or other systemic conditions, addressing the underlying cause is central to resolving the bleeding.
“Courtney was INCREDIBLE. She took the time to educate not only me as a patient but she also took time to listen to the intended parents and answer any questions they had.”
—DelCharco M.D. OB/GYN Patient Testimonial
You Do Not Have to Live With It
Abnormal uterine bleeding is common, but common does not mean something that has to be accepted. Effective evaluation and treatment options exist for virtually every cause of abnormal bleeding. At DelCharco M.D. OB/GYN in Ocala, Florida, our team provides comprehensive evaluation of heavy periods and all forms of abnormal uterine bleeding. Schedule an appointment or call us at (352) 690-6300 to get started.